Childhood Asthma Control Test for children 4-11 years old.

Childhood Asthma Control Test for children 4-11 years old.
Name

First NameLast Name
Date

MonthDayYear
Date
Know the score.

This test will provide a score that may help your provider determine if your child's asthma treatment plan is working or if it might be time for a change.

How to take the Childhood Asthma Control Test

Step 1. Let your child respond to the first four questions (1-4). If your child needs help reading or understanding the question, you may help, but let your child select the response. Complete the remaining three questions (5-7) on your own and without letting your child's response influence your answers. There are no right or wrong answers.

Step 2. Write the number of each answer in the score box provided.

Step3. add up each score box for the total.

Step 4. Take the test or download to the provider to talk about your child's score.

If your child's score is 19 or less, it may be a sign that your child's asthma is not controlled as well as it could be. No matter what the score bring this test to your provider to talk about your child's results.
Have your child complete these questons.
1. How is your asthma today?

Very badBadGoodVery good
Calculation
2. How much of a problem is your asthma when you run, exercise or play sports?

A big problem, I can't do what I want to do.It's a problem and I don't like it.It's a little problem but it's okay.It's not a problem
Calculation
3. Do you cough because of your asthma?

Yes, all of the time.Yes, most of the time.Yes, some of the time.No, none of the time.
Calculation
4. Do you wake up during the night because of your asthma?

Yes, all of the timeYes, most of the timeYes, some of the timeNo, none of the time
Calculation
Please complete the following questions on your own.
5. During the last 4 weeks on average, how many days per month did your child have any daytime asthma symptoms?

Not at all1-3 days/mo4-10 days/mo11-18 days/mo19-24 days/moEveryday
Calculation
6. During the last 4 weeks, on average, how many days per month did your child wheeze during the day because of asthma?

Not at all1-3 days/mo4-10 days/mo11-18 days/mo19-24 days/moEveryday
Calculation
7. During the last 4 weeks, on average, how many days per month did your child wake up during the night because of asthma?

Not at all1-3 days/mo4-10 days/mo11-18 days/mo19-24 days/moEveryday
Calculation
Total Score
Should be Empty: